Most attending physicians well out of training know of the continued discussions on local, regional, and national levels regarding the most “acceptable” amount of hours residents in training are able to work in any given week. I trained in New York state (Syracuse) in the mid-1990s, fresh off of statewide regulations limiting overage due to some high-profile cases out of NYC involving adverse patient outcomes at the hands of fatigued physicians in training. However, no matter how well enforced many of these statutes are by states, training hospitals have always seemed to have the final say — citing financial and training constraints.

This week’s NEJM includes guidelines (still in an advisory period before final recommendations are proposed) put forth by the residency programs’ accrediting body. Among other things, a tiered system of hours is offered for first year residents (interns) to cap hours at no more than 16h/day, as opposed to more senior residents who may be in a better position to supervise and prevent error. These proposals may not go far enough, though, as oftentimes there are a host of other factors at play in overall patient care delivery by residents in an academic hospital setting — qualitative measures that are difficult to quantify for the purpose of making simple preventive interventions. | LINK [PDF]

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